MEDICARE: NATALIE E. HENKE, DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	2901017244	MI

General Provider Information

NPI Number	:	1801294103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATALIE E. HENKE, DDS, PLLC

Provider Business Mailing Address
First Line	:	2770 CARPENTER RD
Second Line	:	SUITE 120
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-4104
Country	:	US
Telephone Number	:	734-971-6400
Fax Number	:	734-971-4427

Provider Business Practice Location Address
First Line	:	2770 CARPENTER RD
Second Line	:	SUITE 120
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-4104
Country	:	US
Telephone Number	:	734-971-6400
Fax Number	:	734-971-4427

Authorized Official
Title or Position	:	DDS/OWNER
Name	:	DR. NATALIE ELIZABETH HENKE
Credential	:	DDS
Telephone Number	:	734-971-6400

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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